Tips on Managing Pediatric Airways

Thursday, March 7, 2013

Management of the pediatric airway and respiratory distress is a key skill necessary for the management of children in the prehospital setting. Robert Felter, MD, FAAP, CPE, FACPE, covered this topic in depth at his EMS Today session, "Respiratory Distress in the Pediatric Patient."

Felter noted that most pediatric cardiac arrests are secondary to respratory failure or volume depletion. Appropriate management of respiratory distress can often avoid a cardiorespratory arrest, he said.

A key point for providers to remember: Children's airways are different from adults both in anatomy and physiology. Anatomical differences include:

The size of the airway

The plasticity of the airway

Location and structure of the epiglottis.

Unlike adults, the narrowest part of the child's airway is at the cricoid ring, Felter noted. This has direct implications if a child needs endotracheal intubation. Understanding the anatomical differences will allow the provider to recognize and manage the patient with respiratory distress and impending respiratory failure.

Felter also highlighted another important difference: Children at rest have little respiratory reserve. Thus, if a disease (e.g., croup) or a situation (e.g., foreign body) causes compromise, the first response is increasing the respiratory rate--this is often the first sign of distress, Felter noted.

Other disease processes may have a variety of physical findings. These include noisy respirations (wheezing, stridor, gunting), retractions, nasal flaring and see-saw respirations. These physical findings will determine which interventions are needed for the presenting clinical signs.

Intervention in pediatric patients with airway issues ranges from observation to intubation. Multiple airway adjuncts are available to the pre-hospital provider, including:

Oxygen

Nasal airways

Oral airways

Endotracheal intubation

Cricothyroidotomy

Felter discussed these interventions as well as common causes of respiratory distress in pediatric patients, including airway foreign bodies, epiglottitis, croup, and bronchiolitis.